Ellis, W, MD

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Additional Specialties: Physical Medicine/Rehabilitation, Neurology

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Extra Phones: Fax: (510) 849-4995
Payment method: master card, visa
Neighborhoods: North Hills, Claremont Elmwood
Other Link: http://www.doctorellis.com
Categories: Physicians & Surgeons, Physical Therapists, Physicians & Surgeons, Cosmetic Surgery, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gynecologic Oncology, Physicians & Surgeons, Gynecology, Physicians & Surgeons, Internal Medicine, Physicians & Surgeons, Neurology, Physicians & Surgeons, Ophthalmology, Physicians & Surgeons, Orthopedics, Physicians & Surgeons, Pain Management, Physicians & Surgeons, Physical Medicine & Rehabilitation, Physicians & Surgeons, Rheumatology (Arthritis), Physicians & Surgeons, Vascular Surgery
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Phone: (510) 849-4703

Address: 2445 Carleton St, Berkeley, CA 94704

Website: http://www.doctorellis.com

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Ellis, W, MD

General Practitioners

Arthritis
“Effective recombinant human erythropoietin on anemia and disease activity in patients with rheumatoid arthritis and anemia of chronic disease: a randomized placebo controlled double-blind 52 week clinical trial”, Peeters H, Jongen-Lavrenci M, Vreugdenhil G, and Swaak A.
Fibromyalgia
A number of other disorders with typically contested etiologies, chronic pain, changes in the ECM, and evidence for neurogenic inflammation come to mind. These include migraine, complex regional pain syndrome, fibromyalgia, temporo-mandibular joint syndrome, chronic cough, adiposis dolorosa, and even chronic fatigue syndrome (32,33,34,35,36,37,38). There are, probably, others.
Rheumatology
Irritable Bowel Syndrome
Interestingly, this is not the only disorder in which this sequence of events occurs. Asthma, chronic regional pain syndrome, irritable bowel syndrome, possibly multiple sclerosis (as well as a number of others) are all initiated and maintained by this cascade of abnormal nerve reactivity and inflammation (neurogenic inflammation). In all of these, one finds abnormally reactive nerves, glia, mast cells, macrophages, and activated white blood cells perpetuating a dysfunctional vicious cycle.

Ophthalmologists

Glaucoma
The first point gives credence to the wide variety of symptoms (besides pain) treatable with cannabis previously dismissed as made up, or at best, placebo. There is a history of over 3000 years of medicinal use of cannabis by serious and famous physicians for a wide variety of disorders (4). Given our current knowledge, this implies that many compounds can be selectively important and active in specific disorders and not in others. The huge amount of potentially active substances, many acting synergistically, explains how one plant can heal such a wide variety of diseases ranging from multiple sclerosis to glaucoma and even, possibly, some cancers. The nerve (neurogenic) pain that accompanies many of these disorders is also helped, often dramatically (5).

Female Infertility
Endometriosis
Anecdotally, Heparin has relieved pain in multiple other disorders (see "Innervated Fibrosis" front page this web site), most notably, at my hands, that of chronic low back pain in individuals with diabetic neuropathy as well as a few women with moderate endometriosis.

Interstitial Cystitis
Interstitial cystitis is yet another disorder with multiple contending etiologies. Symptoms are often severe, progressive, and difficult to treat. Increased submucosal nerves staining for NGF, CGRP, and SubP intimately co-exist with mast cells which are often degranulated on electron microscopy, all proliferating in an increasingly fibrotic extra cellular matrix (ECM) (24). These submucosal nerves are immature and sensitized to respond to minimal distension with proinflammatory peptides. This neurogenic inflammation forms a vicious cycle of increasing pain, bladder dysfunction, dyspareunia and malaise. Again, the self-perpetuation of new neurites, inflammation and fibrosis, restricted, in this case, to the ECM, produces and then spreads symptoms and dysfunction. The perpetuated neural immaturity and inflammation seem key to the disease process. Heparin will often be effective when instilled into the bladder, showing the importance of neurogenically induced cytokines and growth factors (25).

Neurology
“The association between ACE inhibitors and complex regional pain syndrome: Suggestions for a neuro-inflammatory pathogenesis of CRPS”...
Carpal Tunnel Syndrome
In over half of these patients, initial symptoms are pain in the shoulder arm and hand. Following initial injury symptoms originate locally and then spread both distally and centrally, driven by the released cytokines (15). Patients with repetitive work injury usually develop hand pain initially followed by proximal spread of symptoms. Many of these patients therefore receive carpal tunnel decompressions with no benefit, but then do receive significant relief from thoracic outlet decompressions, underscoring the importance of the brachial plexus lesion as the underlying cause of the referred pain in the forearm, wrist, and hand.
Neurolysis
NTOS frequently becomes chronic with spreading and migrating sensory, motor and autonomic dysfunctions that are poorly understood. Intraoperative thermography, microscopy and cytokine staining revealed " innervated fibrosis" of brachial plexus nerve trunks leading to the local presence of pro-inflammatory cytokines. Because similar abnormal, actively secreting growths have been reported in a wide variety of chronic, painful disorders, indicating a commonality, we propose a model involving potentially de-differentiated neurites, Schwann cells as well as activated mast cells, macrophages and fibroblasts to account for symptom formation, progression, and intransigence. This conceptual structure suggests new strategies for better symptom control, including thorough brachial plexus neurolysis at the time of operation, perineural anti-inflammatory treatment, and systemic anti-inflammatory modulation.
Multiple Sclerosis

Ultrasound
One should also bear in mind that other disorders can cause generally similar symptoms and include pathologies at the neck, shoulder, and shoulder blade, as well as the very rare tumor. A variety of systemic diseases can produce these symptoms through other mechanisms that irritate the brachial plexus. Because of this, a thorough blood and imaging workup is a routine requirement and includes analyses for systemic diseases (autoimmune, hormonal, and tumorous), x-ray for both bony and spinal abnormalities, and electrodiagnostics for frank peripheral neuropathies. Magnetic resonance imaging (MRI) of the brachial plexus, using 3-D reconstruction or neurography, can often be helpful in determining localized strictures or deviations of the normal course of the nerves in objectively substantiating abnormalities that point at TOS. Doppler ultrasound, comparing flow with the arm extended and flow with the arm to the side, can also be helpful. Electrodiagnostics are not as helpful, but they rule out other potential causes. I have found thermography to be a very sensitive indicator of abnormal peripheral nerve sensory function/irritation and that it objectively substantiates abnormalities much more frequently than any other imaging modality.
MRI
Hypnosis with an experienced hypnotist and a patient able to be deeply hypnotized (critical) can be very helpful in multiple ways: changing activity patterns, pain and inflammation control, and by teaching autohypnosis for symptom flares (18-19). The precise mechanism(s) of action are clearly psychogenic but still remain largely unknown despite evidence of obvious (MRI, EEG) cerebral activation and the often dramatic ability to influence and change sensory and autonomic functioning. Debate continues as to whether hypnosis is truly a qualitatively different state of consciousness or merely a form of relaxation.
X-Rays

Orthopedics
Whiplash
Hand, shoulder, and arm pain (in the absence of other disease) is the result of a collection of events that can go wrong in the large bundle of nerves traversing the space above the collarbone. These events range from direct injury to repetitive work activities. Abrupt stretching, occurring in auto accidents with attendant “whiplash,” and often accompanying sudden compression from seat belts, is common. Direct trauma, as in an industrial injury or in fractures of the collarbone, produces the same symptoms. However, more commonly (especially over the last several decades), this constellation of symptoms has been shown to be the result of repetitive activities. Controversy about the causes and diagnosis of hand, shoulder, and arm pain continues. This controversy is largely a sterile one, often arguing about the specific nomenclature of the diagnosis to the detriment of the individuals afflicted. Indeed, the term “thoracic-outlet syndrome” (TOS) is anatomically a poor choice for these injuries, as they often involve more than just the thoracic outlet and are often named “cervical brachial syndrome,” “costoclavicular syndrome,” “scalenus anticus syndrome,” “periforaminal soft-tissue syndrome,” “double- or triple-crush injuries,” as well as “brachial plexus neuritis”. TOS happens to be the more generally accepted term.
Neurosurgery
Vascular Surgery
"Thoracic-Outlet Syndrome: Supraclavicular Approach", S.W.K.Cheng,W.V.Ellis, R.J.Stoney in Rob & Smith's Operative Surgery "Vascular Surgery" 5-th ed., C.Jamieson & J.Yao eds. Chapman & Hall Medical, 1994, pp.475-482

Plastic Surgeons

Breast Reduction
In my own series of over fifteen hundred patients with this disorder, there has been a 14:1 female-to-male ratio. In most other series, this ratio varies from 3:1 to 7:1. This disorder has a clear-cut and, as yet, unexplained predilection for women, which has been variously assumed to be due to work choice, poor posture, large breast size, and a penchant for complaining. None of these, in fact, are entirely convincing, although I should note that women with large breasts and TOS do report a moderate decrease in symptoms following breast reduction.

Lesions
Because of this, our group attempted to determine what factors correlated with success after surgery by means of intraoperative infrared imaging. This technique, intraoperative thermography, allows the almost immediate (within seconds) visual identification of the irritation or relief of a specific peripheral nerve or trunk during surgery by imaging the more distal skin surface., Thus, the removal of any offensive structures is immediately apparent. Not surprisingly, such structures turned out to be mainly compressive, actively deforming the large nerve trunks with hypertrophied or fibrotic scalene muscles or fibrous bands. However, we also noticed small (1/2-2cm.) adherent fibrotic tags which were consistently present. When these were resected, we found that better results were seen more consistently than with any other of the offending lesions (3).
Burns

Physical Therapists

Physical Therapy
Given, that physical therapy, opiates, muscle relaxants, anti-epileptics, NSAIDs, and operative interventions do not consistently give acceptable results in patients with NTOS and that symptoms can return in the best post-operative results, alternative therapies continue to be relevant. These are modalities for which rigorous proof of mechanism or effectiveness is controversial or lacking, but may, nonetheless, be of benefit in patients with NTOS. Specifics vary, but their very existence underlines the inadequacy of much of our understanding and treatment of neuropathic pain, of which NTOS is an example. Finally, wether prescribed or not, patients may choose to treat themselves with such and even the most empiric clinician needs to have a sense of what issues are thus created.
Shoulder Pain
Back Pain

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